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Blocking a rash diagnosis: a rare case of infective endocarditis
  1. Brittne Halford1,
  2. Mariah Barstow Piazza2,
  3. Haley Berka2 and
  4. Caitlin Taylor2
  1. 1 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Brittne Halford, bhalford{at}


We report a case of a previously healthy, afebrile patient who presented with subacute bilateral lower extremity rash and complete heart block, which was later found to be secondary to infective endocarditis. His transoesophageal echocardiogram detected multiple vegetations and blood cultures were positive for Granulicatella adiacens, a nutritionally variant streptococcus that is a normal component of oral flora and thought to be responsible for approximately 5% of all cases of streptococcal endocarditis. Due to concerns for renal failure, the patient was treated with an unconventional regimen of ampicillin and ceftriaxone. He underwent a valve replacement and pacemaker placement and has done well since hospital discharge.

  • cardiovascular system
  • arrhythmias
  • drugs: infectious diseases

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  • Contributors BH serves as the corresponding author, supervised patient care and the manuscript construction, revisions and submission. CT contributed to the care of the patient, research and discussion. HB and MBP acquired patient data and contributed to manuscript construction.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.